Senior Medical Director, Medical Management (2026-50210)

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When you join the UMass Chan Medical School team, you join us in advancing together to improve the health and well-being of our diverse communities throughout Massachusetts and across the US and the world. Together, we lead in education, research, health care delivery, and public service. Your life's work is more than a career. It's an expression of your passion, intellect, skill, and drive. UMass Chan"s commitment to excellence, innovation, competitive benefits, and work-life integration will allow you to build a professionally rewarding career as we work together to better or improve the health of people around the globe.

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Senior Medical Director, Medical Management

Job Number: 2026-50210

Category: Management

Location: Boston, MA

Shift: Day

Exempt/Non-Exempt: Exempt

Business Unit: ForHealth Consulting

Department: ForHealth Consulting - Office Of Clinical Affairs - W401300

Job Type: Full-Time

Union Code: Non Union Position -W60- Non Unit Professional

Num. Openings: 1

Post Date: June 24, 2026

Work Location: Hybrid

Salary Minimum: USD $220,000.00/Yr.

Salary Maximum: USD $260,000.00/Yr.

The Senior Medical Director for Medical Management will lead medical management strategy and operations for the MassHealth Office of Clinical Affairs to ensure the delivery of medically necessary, cost-effective, and high quality care for MassHealth members. Working closely with clinical and operational leaders within the Office of Clinical Affairs, this leader will oversee program initiatives related to utilization management (including prior authorizations), medical coverage policy, and care management.

Medical Management Strategy and Policy

• Leads development and implementation of Office of Clinical Affairs strategy for medical management to ensure appropriate, efficient, and high quality care delivery
• Collects, analyzes and reports on medical management metrics to identify trends and recommend interventions
• Accountable to improving efficiency, cost-effectiveness, and quality in OCAs medical management programs, including through use of new technology as appropriate
• Contributes to MassHealths cross-agency medical management strategy

Medical Management Programs

• Oversees Office of Clinical Affairs Medical Management Programs and functions
• Oversees and contributes to OCA utilization management initiatives, including related to prior authorization, concurrent review, and retrospective review
• Oversees and contributes to development and implementation of clinical coverage policies, including assessment of new and existing technologies.
• Oversees and contributes to clinical reviews of providers
• Reviews, analyzes, and responds to quality and safety data
• Ensures high-performing medical management programs that adhere to all relevant regulatory and other requirements, including those set forth by CMS and other oversight entities

Stakeholder Engagement

• Advises and collaborates with the Chief Medical Officer (CMO) and Medical Directors on

strategic issues involving medical management programs

• Serves as a lead interface for OCA medical management programs with other teams throughout the agency
• Leads and/or supports external stakeholder engagements regarding coverage and medical management of services for MassHealth members

Leadership

• Manages clinical and non-clinical staff who are directly responsible for executing on OCAs medical management initiatives
• Ensures Medical Management staff maintain up-to-date knowledge, skills and abilities

related to the administration of assigned responsibilities and functions

• Oversees relevant contractors performing utilization management reviews on behalf of OCA/MassHealth

Other

• May engage in other clinical policies and program work within the MassHealth portfolio
• Other duties as assigned

LICENSURE/CERTIFICATION

• Current, unrestricted physician license in Massachusetts throughout employment with OCA

REQUIRED EDUCATION

• M.D. or D.O. degree required
• Board Certified in specialty recognized by the American Board of Medical Specialties or the American Osteopathic Association Specialty Certifying Boards; Internal Medicine or Family Medicine preferred

REQUIRED QUALIFICATIONS

• At least 5 years experience in direct patient care post-residency
• At least 5 years experience in utilization management in a managed care organization/health plan
• In active clinical practice throughout employment with the Office of Clinical Affairs; internal medicine or family medicine preferred
• Thorough knowledge of the principles and practices of medical management including utilization management
• Excellent oral and written communication and presentation skills
• Must work two days per week on site in Boston and/or Quincy during normal business hours

Preferred Qualifications:

PREFERRED EDUCATION

• Master of Health Administration (MHA), Master of Public Health (MPH), or Master of Business Administration (MBA) in Healthcare Management preferred

PREFERRED QUALIFICATIONS

• Demonstrated commitment to serving Medicaid patients
• Thorough knowledge of Medicaid and related regulations

Posting Disclaimer:

This job posting outlines the primary responsibilities and qualifications for the role but is not intended to be an exhaustive list. Duties and expectations may evolve in response to the needs of the department and the broader institution.

In alignment with our commitment to pay transparency, the base salary range for this position is listed above (exclusive of benefits and retirement). At UMass Chan Medical School, final base salary offers are determined based on a combination of factors, including your skills, education, and relevant experience. We also consider internal equity to ensure fair and consistent compensation across our teams.

Please note that the range provided reflects the full base salary range for this position. Offers are typically made within the midrange to allow for future growth and development within the role.

In addition to base pay, UMass Chan offers a comprehensive Total Rewards package, which includes paid time off, medical, dental, and vision coverage, and participation in a 401(a)-retirement plan, with the option to contribute to a voluntary 403(b) plan.

UMass Chan welcomes all qualified applicants and complies with all state and federal anti-discrimination laws.

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